H.R. 9972 — American Patients First Act of 2026

This section adds skin substitute products to Medicare Part B coverage as a new benefit category. It sets payment at $457 per square centimeter for products furnished from January 1, 2027, through December 31, 2030, defines the term to include cellular, tissue, biological, or synthetic wound materials meeting domestic sourcing and distribution requirements, and excludes such products from certain reporting requirements during that period.

This section requires prepayment review of Medicare claims for skin substitute products submitted by specified providers beginning January 1, 2027, and prior authorization for such providers beginning January 1, 2028, with removal after 180 days if approval rates exceed 90 percent. It directs revocation of billing privileges or referral for exclusion of outlier providers with denial rates above 75 percent over six consecutive months beginning January 1, 2029. It identifies the top 3 percent of providers by total payments as outliers every two years through December 2036, makes the list public, and transfers $2.5 million annually from the Supplementary Medical Insurance Trust Fund for FY2028 through FY2031. It applies uniform coverage criteria to all skin substitute products furnished in 2027.

This section directs the Secretary of Health and Human Services to submit a report by January 1, 2030, to the House Committees on Energy and Commerce and Ways and Means and the Senate Committees on Health, Education, Labor, and Pensions and Finance. The report must analyze U.S. production costs for skin substitute products and patient access to those products along with evidence of their effectiveness.